psychological explanations for schizophrenia: family dysfunction Flashcards
what is family dsyfunction?
processes within a family which are risk factors for the development and maintenance of schizophrenia
what are examples of family dysfunction which influence schizophrenia? (3)
- schizophrenogenic mother
- double-bind theory
- expressed emotion
how did fromm-reichmann (1948) propose a psychodynamic explanation for schizophrenia?
- based on accounts she had heard from her patients about their childhoods
- many of her patients spoke of a particular ‘type’ of parent
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what qualities does a schizophrenogenic mother have? (fromm-reichmann)
- cold
- rejecting
- controlling
- tends to create a family climate characterised by tension and secrecy
- overprotective
- self-sacrificing
- moralistic about sex
- fearful of intimacy
how does having a schizophrenogenic mother lead to schizophrenia?
- distrust, resentfulness and instability is induced by such a parent
- distrust develops into paranoid delusions (being persecuted by another person), and ultimately schizophrenia
double-bind theory: bateson et al. (1972)
- agreed that family climate is important in the development of schizophrenia, but emphasised the role of communication style within a family
- this is neither the main type of communication in the family of someone with schizophrenia, nor the only factor in developing schizophrenia; just a risk factor
describe the double-bind theory
- developing child regularly finds themselves in situations where they fear doing the wrong thing, but receive mixed messages about what this is
- unable to comment on the unfairness of the situation or seek clarification
- when they ‘get it wrong’, the child is punished by withdrawal of love
- child is punished by doing what was asked, then punished again when parent gives no reason for pushing them away
what are the consequences of double-binding which lead to schizophrenia?
- child is left with an understanding of the world as confusing and dangerous
- child learns they cannot trust the messages they receive from others
- do not trust their own feelings and perecptions
- leads to symptoms like disorganised thinking and paranoid delusions
- child becomes confused and loses grip on reality
- negative symptoms of social withdrawal and flat affect may be an appropriate and logical response to double-bind situations
research support for double-bind: berger (1965)
schizophrenics reported a higher-recall of double-bind statements by their mothers than non-schizophrenics
what is the issue with research into family dysfunction?
- evidence is unreliable as patients’ recall may be affected by schizophrenia
- data is retrospective
- correlation not causation
research refuting double-bind: liem (1994), hall and levin (1980)
found no difference in patterns of parental communication b/w families with a schizophrenic child compared to ‘normal’ families
what is expressed emotion (EE)?
level of emotion, particularly high negative emotion, expressed towards a person with schizophrenia by their carers, who are often family members
what does high EE involve? (3)
- critical comments through both tone and content, occasionally accompanied by violence
- hostility towards patient, including anger and rejection
- emotional overinvolvement in patient’s life, including needless self-sacrifice
what is the influence of high EE on the individual?
- serious source of stress
- leads to higher relapse rates
- stress can trigger the onset of schizophrenia in someone who is already vulnerable due to their genetic makeup (diathesis stress model)
evaluation: research support linking family dysfunction to schizophrenia (read et al. 2005)
- adults with schizophrenia are disproportionately likely to have insecure attachment, particularly type C or D
- 69% of women and 59% of men with schizophrenia have a history of physical and/or sexual abuse
- these are indicators of family dysfunction
evaluation: research support linking family dysfunction to schizophrenia (mørkved et al. 2017)
- most adults with schizophrenia reported at least one childhood trauma, mostly abuse
- family dysfunction may make people more vulnerable to schizophrenia
evaluation: explanations lack support
- evidence to support childhood family-based stress but almost none for schizophrenogenic mother and double bind
- these theories are based on clinical observation of people with schizophrenia and an informal assessment of their mothers’ personalities, but not systematic evidence
- family explanations have been unable to account for the link between childhood trauma and schizophrenia
evaluation: parent-blaming
- highly socially sensitive
- mothers are particularly blamed
- blaming parents who already have to watch their child experience symptoms of schizophrenia is insensitive
evaluation: no such thing as schizophrenogenic mother
- only a small percentage of women who arguably fit the criteria of schizophrenogenic mother actually had schizophrenic chidlren
- many schizophrenics were found to have mothers who did not fit the criteria
- theory has been criticised for hindering progress in psychiatry and understanding of the disorder
evaluation: research support for EE (brown 1966)
- followed up people recovering from schizophrenia and discharged from hospital for 9 months
- conducted interviews with family members to determine level of EE
- families with high EE had 58% of people with schizophrenia returning to hospital for further treatment, compared to only 10% of those from low EE families
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evaluation: limitations of EE
- difficult behaviour from sufferer may influence family behaviour patterns rather than the other way around
- unclear whether EE is causal agent in relapse rates or just a reaction to the patient’s behaviour
- high EE communication patterns are not specific to schizophrenia (eg. depressed, EDs)
- more evident in western families
- EE usually measured with one interview, which is unreliable
evaluation: diathesis-stress
- psychological explanations look at person’s environment
- families can influence onset (through socialisation) and maintenance (through high EE)
- diathesis-stres also considers biological predisposition
